Studies have demonstrated that intensive disease management of diabetes can prevent the progression of diabetes related complications. However, implementation of well defined guidelines for intensive disease management, including preventive service guidelines for the early detection of microvascular disease, has been suboptimal. Barriers to success occur at multiple levels, including health care systems, health care providers and patients. In rural regions of the U.S., reduced availability of primary care providers and specialty services, including diabetes education, present additional barriers to effective diabetes care. Therefore, the goal of the project is to improve provider adherence American Diabetes Association (ADA) best practice guidelines by restructuring office workflow in a primary care clinic such that diabetes management shifts from a physician-centered to a coordinated office approach to care. In a coordinated office approach, clearly defined tasks for monitoring and documenting diabetes preventive services will be distributed from the primary care provider to front and back office staff. This should help "automate' or "standardize" diabetes preventive care. To achieve this, 4 Diabetes Preventive Service Modules based on best practice guidelines will be developed and implemented. Each module addresses a key diabetes complication area (vascular, eye, renal, and foot), identifies clearly defined tasks for office staff and providers, and has a patient education component. Specific aims are to determine: 1) if office workflow can be restructured to create a coordinated office approach to diabetes management rather than usual physician centered approach; 2) if a coordinated office approach to diabetes management improves diabetes patient care; and 3) if a coordinated office approach to care improves diabetic patients' knowledge of ADA recommended preventive services. Disease-specific outcomes will include physiologic variables (HbA1c, blood pressure, lipid levels), measurement and documentation of preventive services (dilated eye exam, monofilament exam, microalbumin testing) and patient's knowledge of diabetes preventive services measured by a diabetes knowledge test. Results should show improved outcomes and patient knowledge in a primary care clinic implementing a coordinated approach to diabetes care from baseline and compared to a primary care clinic providing a usual physician centered approach to care. [unreadable] [unreadable] [unreadable]